'Project Lazarus' Making Headway on Opioid Overdoses

Megan Brooks

June 17, 2014

BOSTON — Project Lazarus, a community-based opioid overdose prevention program, has dramatically cut overdose deaths in Wilkes County, North Carolina. It has been so successful it's being rolled out statewide and implemented in military bases and tribal groups. Project leaders are consulting with leaders in other US communities seeking to develop their own programs.

Gil Kerlikowske, former director of the White House Office of National Drug Control Policy, has called Project Lazarus a model for other communities.

The project was the focus of a presentation at the recent International Conference on Opioids, given by David M. Marks, PhD, from the Duke Pain Care Clinic, Durham, North Carolina, and James W. Finch, MD, president of the North Carolina Society of Addiction Medicine.

Wilkes County, population 69,500, is a socioeconomically depressed area located in the foothills of the Appalachian Mountains. There is a high chronic pain burden in the county due to physically demanding jobs, mainly in the logging, textiles, and farming industries.

Project Lazarus is a public health nonprofit organization launched in 2007, with early efforts beginning in 2004, in response to extremely high rates of death from opioid overdoses in Wilkes County (roughly 4 times higher than the state average). In 2007, Wilkes County had the third highest drug overdose death rate in the nation, according to the Centers for Disease Control and Prevention (CDC).

"People were alarmed by this and took action," Dr. Marks noted in an interview with Medscape Medical News. And it's paying off.

Collaboration Key

According to the Project Lazarus Web site, overdose deaths fell 69% in Wilkes County between 2009 and 2011 and the County had logged 28 straight months of steady declines in overdose deaths in those years.

At the same time, Wilkes had higher opioid prescribing than the state average, with less than 1% change in how many Wilkes residents received an opioid pain reliever (7.5% to 8% each month; state average is 5.8%).

Yet, in 2011, not a single Wilkes County resident died of a prescription opioid from a prescriber within the county, down from 82% of those with a prescription in 2008. Hospital emergency department visits for overdose and substance abuse fell 15% between 2009 and 2010 in Wilkes County, compared with a 6.9% increase in the rest of the state.

"More opioid prescriptions don't automatically mean more deaths. It is possible to deliver good pain relief without a heavy overdose burden. But it takes the whole community to make it happen," Fred Wells Brason II, executive director of Project Lazarus, told Medscape Medical News.

Project Lazarus collaborates with Community Care of North Carolina's Chronic Pain Initiative to help deliver better pain relief while reducing overdose risk at the same time.

More opioid prescriptions don't automatically mean more deaths. It is possible to deliver good pain relief without a heavy overdose burden. Dr. Fred Wells Brason II

The Project Lazarus Chronic Pain Initiative addresses these challenges by partnering with several individuals and organizations, including Governor's Institute on Substance Abuse, the North Carolina Hospital Association, local hospitals and emergency departments, local health departments, primary care physicians, faith-based programs, and law enforcement.

Project Lazarus "really rallied the major stakeholders and got people to buy-in to the problem and try to address it. They basically would talk to anyone that would listen about the problem," Dr. Marks told Medscape Medical News.

The Project Lazarus Model is based on the premises that drug overdose deaths are preventable and that all communities are ultimately responsible for their own health. The Model has 10 components. The 3 main components that must always be present are (1) public awareness, (2) coalition action, and (3) data and evaluation.

The next 7 components can be implemented at various times depending on the needs of the community: (4) provider education, (5) hospital education policies, (6) diversion control, (7) pain patient support, (8) harm reduction, (9) addiction treatment, and (10) community education.

Statewide Rollout

The project runs one-on-one provider education; holds continuing medical education sessions on pain management at local hospitals; and encourages providers to use opioid treatment agreements and the NC Controlled Substance Reporting System (CSRS), which helps doctors identify and prevent diversion of prescribed controlled substances. "There was a big push to get more doctors signed up for the CSRS, which has happened," Dr. Marks said.

Project Lazarus also works with emergency departments to reduce the number of pills prescribed, with law enforcement on medication "take-back" programs, and with local mental health centers to expand addiction treatment services. Purdue Pharma LP, with other Project Lazarus funding sources, has provided funds to purchase and distribute naloxone kits for reversal of overdoses.

There is now a statewide effort to initiate Project Lazarus–like interventions in other NC communities. The Kate B. Reynolds Charitable Trust is supporting statewide rollout to the tune of $1.3 million with a matching grant from the NC Office of Rural Health, as well as the Mountain Area Health Education Center CMS Innovations grant.

Funding sources for Project Lazarus have included industry, community, and state support.

International Conference on Opioids. Presented June 10, 2014.


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